Serious sling complications may be under-reported

Montreal-Serious complications associated with implantation of synthetic midurethral sling (SMUS) surgery may be under-reported in the peer-reviewed literature and serious adverse outcomes and surgical failures are on the order of 15.3%, according to findings from a systematic review presented at the International Continence Society annual meeting in Montreal.

"There appears to be a pretty high complication rate (of SMUS surgery),” said lead author Jerry Blaivas MD, of Weill-Cornell Medical School, New York, and State University of New York Downstate Medical School, Brooklyn. “There is a subset of patients who suffer severe, lifestyle-altering complications in whom a satisfactory outcome is never achieved despite multiple correct surgeries. These unfortunate patients have recently been described as 'changed women,’ " (Female Pelvic Med Reconstr Surg 2014; 20:131-6).

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Despite these concerns, SMUS surgery has gained wide appeal because it can be completed quickly and has minimal short-term morbidity when these serious complications do not occur, noted Dr. Blaivas.

Dr. Blaivas and co-investigators conducted a search of the English-language literature in 2014 to assess complications linked to SMUS surgery, including articles from 2007 onwards. They defined serious complications as those that necessitated more surgery such as urethral obstruction, vaginal, bladder, and urethral erosion, urinary fistulas, bowel injury, and serious infections. They also defined serious complications as those that were refractory to treatment and were lifestyle altering such as chronic pain, de novo overactive bladder, and recurrent or persistent stress urinary incontinence (SUI).

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